Healthcare Provider Details

I. General information

NPI: 1982534335
Provider Name (Legal Business Name): BRUCE ELSEY I DDS, JD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/19/2026
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 E MAIN ST
PICKFORD MI
49774-8936
US

IV. Provider business mailing address

PO BOX 308
PICKFORD MI
49774-0308
US

V. Phone/Fax

Practice location:
  • Phone: 906-647-9201
  • Fax:
Mailing address:
  • Phone: 906-647-9201
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number2901602946
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: